Exit Block of Focal Repetitive Activity in the Superior Vena Cava Masquerading as a High Right Atrial Tachycardia

T, Ino; Miyamoto, Shinjiro; Ohno, Tadaaki; Tadera, Takeshi

doi:10.1111/j.1540-8167.2000.tb00346.x

Cited by 33 publications

(24 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3][4][5][6][7][8] More recently, Ino et al described a case with a 2:1 exit block of repetitive focal activity in a SVC focus manifesting as a high right AT. 13 Furthermore, we found that AT can occur focally from different parts of the SVC, which was confirmed by the SVC angiogram showing the location of the successful ablation sites at various distances above the atriocaval junction and different positions within the SVC (Fig 7). These SVC foci were all located within 30 mm above from the atriocaval junction, which is in accordance with the histological and electrical connections of the musculature between the SVC and the right atrium.…”

Section: Discussionsupporting

confidence: 71%

Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena Cava.

Chang¹,

Lin²,

Chen³

et al. 2001

Jpn Circ J

View full text Add to dashboard Cite

trial tachycardia (AT) originating focally from diverse anatomical structures in both atria has been well described. [1][2][3][4][5][6][7][8] Focal AT is distinguished from macroreentrant AT by its electrophysiological characteristics and electropharmacological responses, and by the approaches to mapping and ablation of the tachycardia. 7,8 The underlying mechanism of focal AT is thought to be automaticity, triggered activity or atrial microreentry. 7,8 Recently, Tsai et al reported an unusual form of focal atrial fibrillation (AF) triggered by ectopic beats originating from the superior vena cava (SVC), and radiofrequency (RF) ablation of the triggering SVC focus was safe and highly effective in eliminating the focal AF. 9 Theoretically, it is possible that focal electrical firing in the SVC could initiate AT in addition to AF; however, the mechanism of this type of focal AT remains unclear. In this study, we describe the distinct electrocardiograms and electrophysiological characteristics in 3 patients with focal AT originating from various parts of the SVC. The location of the successful RF site in the SVC was proven by multi-plane SVC angiography. All 3 patients underwent uneventful ablations of their SVC foci within a few seconds of RF current application. Methods PatientsThe study group were 3 patients with drug-refractory atrial tachyarrhythmias who were admitted for electrophysiological study and RF ablation therapy. Each patient had a focal AT originating from the SVC that had been diagnosed and confirmed by the electrophysiological study, SVC angiography and RF ablation. Two (cases 1 and 2) of the 3 patients did not have significant organic heart diseases detectable by physical examination, chest roentgenograms, echocardiography, and coronary angiography. The other patient (case 3) had one-vessel coronary artery disease. The definition of focal AT was based on previously established criteria. 7,10-12 Electrophysiological Study and RF AblationThe electrophysiological study was performed in a postabsorptive state after each patient gave written informed consent. All antiarrhythmic drugs except amiodarone were discontinued for at least 5 half-lives before the study. Two 6F quadripolar electrode catheters with a 5-mm interelectrode spacing were positioned at the high right atrium and the right ventricular apex, respectively, for pacing and recording. Another 6F quadripolar electrode catheter with a 10-mm interelectrode spacing was positioned across the tricuspid annulus to record the His bundle potential. A 6F decapolar electrode catheter with a 2-10-2-mm interelectrode spacing (Daig Corp) was positioned in the coronary sinus for recording and pacing. A 7F deflec- Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena CavaKuan-Cheng Chang, MD; Yu-Chin Lin, MD; Jan-Yow Chen, MD; Hsiang-Tai Chou, MD, PhD; Jui-Sung Hung, MDThe initiation of focal atrial tachycardia (AT) from the superior vena cava (SVC) remains unclear. In 3 patients (2...

show abstract

Section: Discussionsupporting

confidence: 71%

Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena Cava.

Chang¹,

Lin²,

Chen³

et al. 2001

Jpn Circ J

View full text Add to dashboard Cite

show abstract

“…Conduction block between the atrium and thoracic veins has been reported and is well recognized in the pulmonary veins; however, conduction block from the SVC to the right atrium (RA) is rare [3,5]. In this case, a conduction block at the exit site of the SVC-RA connection was strongly suggested using a circular multipolar catheter (Lasso) and CARTO mapping.…”

Section: Introductionmentioning

confidence: 78%

Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

Nozoe

Koyama

Honda

et al. 2012

Journal of Arrhythmia

View full text Add to dashboard Cite

a b s t r a c tAT caused by SVC fibrillation: Here, we report a case of a 62-year-old man with a history of incessant atrial tachycardia (AT) for several years. An electrophysiological study revealed rapid and irregular activity in the superior vena cava (SVC), but the surface 12-lead electrocardiogram (ECG) exhibited a relatively regular AT (atrial cycle length ¼ 240 ms). CARTO mapping of the right atrium (RA) demonstrated that the earliest atrial activation occurred at the posterior septum of the upper RA (the SVC-RA junction). Intravenous administration of 20 mg adenosine triphosphate (ATP) led to an acceleration of the SVC-RA conduction up to 1:1 conduction, and the atrial cycle length decreased, consequently converting the AT to transient atrial fibrillation (AF). Application of single radiofrequency energy at the earliest atrial activation site during tachycardia terminated the AT and achieved isolation of the SVC from the RA, despite the continued presence of fibrillation in the SVC. We speculated that SVC fibrillation with spontaneous conduction block at the SVC-RA junction was the cause of this AT.

show abstract

“…11,34) In the right atrium, common locations of AT origins are the crista terminalis, right-side of the interatrial septum including the vicinity of the AV node, right atrial appendage, tricuspid annulus, coronary sinus ostium, and the SVC. 11,26,[34][35][36][37][38][39][40][41][42] In the left atrium, AT origin tend to cluster the pulmonary vein ostium, the left atrial appendage, left-side of the interatrial septum, the coronary sinus body, mitral annulus, the ligament of Marshall, or a left-sided SVC.…”

Section: Anatomymentioning

confidence: 99%

“…60) Electrical isolation of the SVC can cure tachycardias originating from the SVC muscle sleeve despite continued focal electrical activity inside the sleeve. 40) Ablation of pulmonary vein tachycardia that targets the ectopic focus is highly effective. However, electrical disconnection of the arrhythmogenic pulmonary vein at the atria -pulmonary vein junction may be a preferable approach in some cases to avoid a risk of pulmonary vein stenosis.…”

Section: Ablation Techniquesmentioning

confidence: 99%

Focal Atrial Tachycardia

Higa

Chen

2006

J Arrhythmia

View full text Add to dashboard Cite

Over the past decade, most of the electrophysiologic mechanisms in patients with focal atrial tachycardias (ATs) have been well studied. Recently, advanced mapping systems have revealed the precise propagation, and the relationship between non-radial propagation pattern and substrate property of focal AT. Non-radial activation pattern of focal AT may mimic macrorentrant AT and may lead to inappropriate ablation strategy. In this review, we will focus on the current state of mapping and ablation techniques, safety, and efficacy associated with the catheter ablation for focal AT. (J Arrhythmia 2006; 22: 132-148)

show abstract

Exit Block of Focal Repetitive Activity in the Superior Vena Cava Masquerading as a High Right Atrial Tachycardia

Cited by 33 publications

References 14 publications

Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena Cava.

Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena Cava.

Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

Focal Atrial Tachycardia

Contact Info

Product

Resources

About